Left Atrial Ball Thrombus Captured on Echocardiography: The Ping-Pong Ball and the Hole-in-One.

IMAGE(S): Left atrial ball thrombus; echocardiography; CT; histopathology.

CASE SUMMARY: Two women with atrial fibrillation and no anticoagulation presented with left atrial ball thrombus. Patient 1 (79 years, severe mitral stenosis) underwent successful surgical resection and survived. Patient 2 (82 years, atrial fibrillation alone) declined surgery; echocardiography captured acute mitral obstruction- the hole-in-one mechanism-and she died 3 days later from cardiogenic shock.

TAKE-HOME MESSAGE: Left atrial ball thrombus may cause fatal acute mitral obstruction and early surgical intervention may alter outcome.